[Computer-guided robot-assisted hip endoprosthesis]

A Bibliometric Analysis of the Top 100 Most Influential Studies on Robotic Arthroplasty

Background

The use of robotics in arthroplasty surgery has increased substantially in recent years. The purpose of this study was to objectively identify the 100 most influential studies in the robotic arthroplasty literature and to conduct a bibliometric analysis of these studies to describe their key characteristics.

Methods

The Clarivate Analytics Web of Knowledge database was used to gather data and metrics for robotic arthroplasty research using Boolean queries. The search list was sorted in descending order by the number of citations, and articles were included or excluded based on clinical relevance to robotic arthroplasty.

Results

The top 100 studies were cited a total of 5770 times from 1997 to 2021, with rapid growth in both citation generation and the number of articles published occurring in the past 5 years. The top 100 robotic arthroplasty articles originated from 12 countries, with the United States being responsible for almost half of the top 100. The most common study types were comparative studies (36) followed by case series (20), and the most common levels of evidence were III (23) and IV (33).

Conclusions

Research on robotic arthroplasty is rapidly growing and originates from a wide variety of countries, academic institutions, and with significant industry influence. This article serves as a reference to direct orthopaedic practitioners to the 100 most influential studies in robotic arthroplasty. We hope that these 100 studies and the analysis we provide aid healthcare professionals in efficiently assessing consensus, trends, and needs within the field.

Cell morphology, viability, osteocalcin activity, and alkaline phosphatase activity in milled versus unmilled surface of the femoral head

PURPOSE

To evaluate cellular activity in milled versus unmilled surface of the femoral head in 21 patients who underwent robot-assisted total hip arthroplasty(THA).

METHODS

The femoral head of 21 consecutive patients who underwent robot-assisted THA for osteonecrosis was used. 10 cc of trabecular bone from the entire milled surface was obtained using a curette. The same amount of trabecular bone was obtained at least 1 cm away from the milled surface and served as a matched control. Cell morphology, viability, osteocalcin activity, and alkaline phosphatase activity in milled versus unmilled surface were assessed.

RESULTS

Cell morphology of the milled or unmilled surface was comparable; cells were smaller in the milled surface. Cell viability was a mean of 40% higher in the milled surface (107.4% vs. 67.2%, p<0.001); cell viability at 5 time points was comparable in each group. Osteocalcin activity of cells was slightly higher in the milled surface (1.43 vs. 1.24 ng/ml, p=0.69). Alkaline phosphatase activity of cells was slightly higher in the unmilled surface (150 105 vs. 141 789 U/L, p=0.078).

CONCLUSION

The milled and unmilled surfaces of the femoral head were comparable in terms of cell morphology, viability, osteocalcin activity, and alkaline phosphatase activity.

[Primary rotatory stability of robot-assisted and manually implanted hip endoprosthesis stems]

In our study we compared the primary rotatory stability of hip endoprostheses implanted with the help of a robot and manually implanted stems. We examined three different types of prosthesis stems: Osteolock (Stryker-Howmedica), CBC (Mathys), and Excia (Aesculap). Ten stems of each prosthesis type were implanted in identical polyurethane foam blocks: five were implanted manually and five with the help of a robot (CASPAR, URS-Ortho). After implantation, the stem was subjected to a defined rotatory stress. The torsional moment necessary to break the stem out of the foam was documented with the help of special software. The force-displacement diagrams after robot-assisted implantations were homogeneous for each type of prosthesis. After manual preparation, the diagrams were very inhomogeneous. The rotatory test also showed very consistent results for the robot-implanted stems. The range of results after manual implantation was much higher. In all types of prostheses the use of the robot system led to a higher rotatory stability compared to the manual group. The CBC stem was most stable for rotatory forces after robot-assisted implantation compared to the other two types. After manual implantation there was no difference in stability between the different stems.